Mark Dybul
Global AIDS Coordinator, USA
  

I would like to thank Msgr. Spreafico and the Communita di Sant�Egidio for inviting me to represent the U.S. Global AIDS Coordinator, Ambassador Randall Tobias who could not be with you today. He extends his warm regards and wishes for a successful meeting.

In a broader sense, I feel privileged to, with Ambassador Nicholson, represent President Bush�s Emergency Plan for AIDS Relief. It is a personal honor for me to serve on a panel with Ambassador Nicholson, one of the U.S.A�s leading emissaries to the faith community.

President Bush has embodied the compassion and generosity of the American people through his unwavering leadership and bold action.

- In 2001, he hosted Secretary General Kofi Anan at the White House to announce the Global Fund for AIDS, Tuberculosis and Malaria, and provided the founding gift for the Fund.

- In 2002, he announced his International Mother and Child HIV Prevention Initiative, a 5 year, $500 million program to reduce the transmission of HIV from mothers to their newborns by 40 percent in 14 countries in Africa and the Caribbean.

- In 2003, he announced his Emergency Plan for AIDS Relief � as Ambassador Nicholson said � a 5 year, $15 billion initiative to turn the tide against global HIV/AIDS by focusing $10 billion to fully scale national treatment, prevention and care in now 15 countries in Africa, Asia and the Caribbean; these 15 �focus� countries are home to 50 percent of the HIV-infected people in the world. In addition, the Emergency Plan will provide $4 billion to extend bilateral HIV/AIDS programs and research in more than 100 countries, and $1 billion in gifts to the Global Fund � bringing total U.S. Government pledges to $1.6 billion.

- In 2004, he announced the International Vaccine Initiative to coordinate global efforts for that greatest hope.

No leader or country has shown such extraordinary leadership and action in the global fight against HIV/AIDS as President Bush and the American people.

Today, we will focus on the President�s Emergency Plan for AIDS Relief. As Ambassador Nicholson noted, the Emergency Plan is the largest international health initiative in history dedicated to a single disease. That bears repeating: the largest international health initiative in history dedicated to a single disease. In 2004 alone, the American people will provide more resources for global HIV/AIDS than all other donor governments combined.

And we are putting those resources to work with the emergency response that the global tragedy requires. Within one month of receiving the first dollar for congress, the Emergency Plan put $350 million dollars in the hands of those serving those in need. By 5 months, we were providing all $865 million available to the 15 focus countries. By the end of this month, we will have put the entire $2.4 billion provided by Congress for the first year of the Emergency Plan to work. Again, more than all other donor governments combined.

But resources alone are not enough. As Ambassador Nicholson noted, each day 8,000 people die from HIV/AIDS, and each day 14,000 men, women and children are newly infected � giving the a death sentence. In certain countries, HIV/AIDS has caused a decrease in life expectancy of more than 30 years � obliterating out 50 years of gains in public health. Hope has turned to despair � money cannot restore hope.

But action can. In HIV/AIDS, we have our own Lazarus effect � the effect of the walking dead being restored to life through effective antiretroviral therapy. As in the beautiful biblical story, the Lazarus effect of antiretroviral therapy spreads hope to individuals, their families and the community.

And so the President has given us very clear and concrete goals � measured one man, woman and child at a time: to treat 2 million HIV-infected persons with life-saving drugs, to prevent 7 million new infections and to care for 10 million HIV-infected persons and AIDS orphans.

We are moving emergently to achieve those goals.

In the first year of funding for the President�s Mother and Child HIV Prevention Initiative in 14 countries, the American people supported HIV counseling and testing for 380,000 pregnant women, and identified and supported the provision preventive short-course therapy to 34,000 of those � resulting in an estimated 5,000 babies born free of HIV who would otherwise have the virus � and the death sentence. As important, the Emergency Plan supported the development of local capacity to fully own the programs by training 15,000 health care workers in mother to child prevention and developing more than 900 sites to provide services.

Although preventing the spread of HIV from mothers to children is an act of mercy, it is not enough. Families must be protected and preserved � mothers and father cannot die, leaving a legacy of a generation of orphans.

And so President Bush took the historic step of committing the United States to provide life-saving treatment. In his own words before a Baptist Congregation in Philadelphia:

�For too long, anti-AIDS programs offered too little treatment for those who had already contracted the disease. And so today we�re helping other nations to buy drugs so that we can extend lives. Because you see, every life matters to the author of life, and so they matter to us.�

Following the President�s lead, the Emergency Plan began treating HIV-infected persons in rural Uganda within days of receiving the first dollars from the U.S. Congress. This week, Ambassador Tobias will support a report to Congress demonstrating that between the initial phases of capacity building until June, and from June, when full implementation began � so over the six months from January 24 to July 31, the Emergency Plan has already supported antiretroviral therapy for nearly 25,000 men, women and children. This early success puts the President�s Plan on target to support treatment for more than 200,000 HIV-infected people in 15 countries by June of next year � the first year of full implementation. This will approximately double the number of men, women and children receiving treatment in all of Sub-Saharan Africa.

And as we provide treatment, we must know that it is safe, effective and of high quality � and then that it is the lowest possible cost. We cannot have two tiers for treatment � one if you are poor and one if you are not. So Ambassador Tobias and the U.S. Secretary of Health and Human Services announced an expedited review to allow drugs produced anywhere in the world by any company to demonstrate the safety, efficacy and quality of their product. To assist in the process, the U.S. Food and Drug Administration has provided technical assistance and pre-application site inspections. Several companies have made public their intent to enter the process while others are working with us without public comment. Assuming that the drugs are safe, effective and of high quality, the Emergency Plan will have access to copy antiretroviral drugs later this Fall.

In addition to rapid movement on treatment, by June of 2005, the Emergency Plan will support care for 1.2 million HIV-infected persons and AIDS orphans. This care will include the first major international initiative to focus on care and support for the dying � to provide death with dignity so that people can meet their maker in peace.

No single initiative will solve the world�s problem; as has been said �the poor we have always with us.� But by turning despair to hope by giving people health, we can do much.

Just over one week ago I was in rural Uganda - Tororo on the Eastern Border with Kenya; the place where the Emergency Plan began providing therapy with in days of receiving funds. I met with an HIV-infected woman and her family in their modest home. The infected mother was among the walking dead 6 months ago when she began treatment. Now she has the strength to tend the family�s little plot of land to bring in 500 Uganda Shillings per day. That is the most successful microfinance story I have heard in a long time. Health and hope will not solve the world�s problems - but it is a very good start.

Allow me to say a few words about the third pillar of President Bush�s Emergency Plan � prevention; the means by which we need neither care nor treatment.

While the greatest hope in prevention is an effective vaccine, and the United States is providing hundreds of millions of dollars each year to help find one, we must be honest and admit that, despite all efforts, we are years away from having one.

The Emergency Plan will stand up for scientific evidence and common sense; we acknowledge the obvious � that the most effective means of prevention is to avoid the actions that result in the transmission of infection; we will ask that people take responsibility for their actions and for their health. The Emergency Plan has been criticized for recognizing that HIV/AIDS is a complex disease � that a single method of prevention has no possibility of success. But we will hold fast to doing what we know is right � to use the best scientific evidence that we have to develop effective programs to ensure our greatest success in protecting men, women, and even children from becoming infected with HIV/AIDS.

And the evidence, and common sense, shows that an effective strategy includes A � abstinence, B- be faithful, and C- the correct, consistent and appropriate use of condoms. As Ambassador Tobias often says � ABC is not a multiple-choice question � chose the one you want � the stakes are too high. The Emergency Plan is rolling out prevention programs focused on ABC throughout the 15 focus countries with the same sense of urgency as the rapid expansion of treatment and care programs.

So President Bush�s Emergency Plan is on the move � on the move with treatment, care and prevention programs. But we are not alone. In fact, the greatest secret of the Emergency Plan seems to be that we are moving in support of national strategies with our local partners, and we are moving together with our international partners. And we must. We know that only together can we turn the tide against HIV/AIDS. While the 2-7-10 goals for treatment, prevention and care are often sited, sometimes we forget to add the other critical elements: 2-7-10 in a sustainable and accountable way. If 2-7-10 are achieved, but local capacity under the national strategy is not fully developed, we will have failed. And unless local capacity for programs, management, accounting, monitoring, evaluation, surveillance, logisitics and supply chain management for drugs and commodities are built, 2-7-10 cannot succeed � we will all fail.

In each of the more than 100 countries where the U.S. works, we know that we are there as guests of the host country. We feel a strong sense of privilege in having the opportunity � granted by the host government � to work side by side with local colleagues and friends in the fight against HIV/AIDS. In fact, part of the reason the 15 focus countries were selected is that the U.S. Government has strong HIV/AIDS teams on the ground � in certain countries for more than 20 years. And we are working with our local friends to build programs and to build capacity. Of the approximately 1,000 funded partners of the Emergency Plan, 60 percent are local groups � we are working hard to increase that number each year of the Initiative. To help ensure that happens, the Emergency Plan is funding hundreds of training programs in the 15 countries � 140 in treatment alone. We are building infrastructure � labs and lab equipment, counseling rooms and HIV/AIDS clinics � and providing mobile counseling and testing, and treatment units.

And this is where the faith community is so important � and why President Bush and the U.S. Congress have emphasized the faith community. Because in so many places in Africa, Asia and the Caribbean, in particular the difficult to reach areas where no one else will go, local capacity IS the faith community. The Emergency Plan cannot succeed in treatment, prevention and care, and in building local capacity without the faith community. Whether it is the entire country of Kenya where 40 percent of all health care is provided by the faith community, or a hilltop in Rwanda where the Catholic archdiocese provides the only health care for miles around, we will never reach those who need to be reached, or provide the loving care those in suffering deserve, without those of you in this room and your communities. This recognition translates into action. Of the approximately 1,000 funded partners of the Emergency Plan, 20 percent are faith-based groups.

Whether it is the Ethiopian Orthodox Church or the national Muslim and Jewish groups in Uganda providing prevention education, or the Lutheran Evangelical Church providing care for orphans in Namibia, or St. Joseph�s hospital in Georgetown, Guyana providing prevention and care, or our hosts for today, Community of Sant�Egidio, providing antiretroviral therapy in Mozambique, all of these and thousands upon thousands more are critical to turning the tide against HIV/AIDS. The Emergency Plan is working to reach out to the faith community in each country. But we can do more, and we must.

While we are working with local partners in each country, the Emergency Plan is working with international partners.

As I mentioned earlier, President Bush joined Kofi Anan in announcing the creation of the Global Fund for AIDS, Tuberculosis and Malaria, and President Bush provided the first gift, and the first second gift of any country. The Global Fund is an essential element of the President�s Emergency Plan. The U.S. is by far the largest donor to the fund � accounting for more than one-third of donations. One way to look at that is to say that the American people provide one-third of every grant made by the Global Fund. The U.S. Secretary of Health and Human Services serves as the Chair of the Global Fund. In country, members of the U.S. Government�s on-the-ground team sit on the Fund�s Country Coordinating Mechanism and provides direct financial and technical support for applications and to recipients. The Global Fund must succeed to turn the tide against global HIV/AIDS � and must move rapidly to provide prevention, care and treatment services.

Recently, a prohibition from the U.S. Congress against the U.S. providing more than one-third of donations to the fund meant that the U.S. could not yet contribute the total amount pledged for 2004; other donors had not kept pace. The law allowed Ambassador Tobias to redirect those funds to bilateral programs. Because the Global Fund is a key component of the U.S. strategy in the global fight against HIV/AIDS, Ambassador Tobias did not redirect those funds. Rather, he is holding them in abeyance in the hope that other donors will increase their gifts to that the American people can complete their pledge to the Fund.

The Emergency Plan coordinates with WHO�s 3 by 5 Initiative and was one of the principle sponsors of UNAIDS 3 ones � one national coordinating body, one national strategy, and one monitoring and evaluation approach. We are partners with the World Bank and UNICEF. The Emergency Plan works with international non-governmental organizations and foundations active in HIV/AIDS. There is plenty of work to go around � and we must all work together.

We have passed an important threshold in the global fight against HIV/AIDS � hope is in sight. If we work together, putting differences aside and finding common ground, we will all turn despair to hope. We can do this because we are passing from the era of empathy to the era of compassionate action � an era with 2 million Lazarus, 7 million who will never get to being among the walking dead from HIV/AIDS, and 10 million people who will know a loving touch to relieve pain, or to care for an orphan. This hope is in our grasp.

From President Bush, to Ambassadors Tobias and Nicholson, to all of us acting on behalf of the generosity of the American people � we are committed to bold and compassionate action as we work with you all as, together, we turn the tide against HIV/AIDS.